We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.
Residency in or relocation to Louisiana is preferred for all positions.
Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.
POSITION PURPOSE
This position focuses care for members that have Medicare and are also entitled to Medicaid. The Case Management Nurse position is responsible for conducting case management, care coordination and quality activities in accordance to CMS standards and Blue Cross Blue Shield’s policies and procedures. The Case Management Nurse telephonically assesses members by evaluating member needs and requirements in order to achieve and/or maintain optimal wellness state. The Case Management Nurse will evaluate enrollees for resource needs and guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Case Management Nurse will work in collaboration with the member, the member’s care providers and a multi-disciplinary team, employing a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues.
NATURE AND SCOPE
This role does not manage people
This job reports to: Departmental Leadership
Necessary Contacts: The departmental leadership, and other divisions within BCBSLA.
QUALIFICATIONS
Education
High School Diploma required
Work Experience
4 years of general clinic experience is required.
1 year of clinical experience in case management, acute hospital discharge planning or utilization review is preferred.
Previous direct clinical care to patients in a behavioral health setting is preferred.
Skills and Abilities
Exceptional interpersonal, verbal, and written communication skills.
Ability to document clearly and concisely.
Strong problem-solving skills.
Ability to work with limited supervision and make decisions based on established policies and procedures.
Accountability – meets established expectations and takes responsibility for achieving results; encourages others to do the same. Employs focus, attention to detail, reliability, and appropriate prioritization to drive outcomes. Sees opportunities to contribute and takes the initiative to create solutions.
Builds trust – consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one’s actions. Prioritizes principles and values over personal or professional gain.
Customer Focus – connects meaningfully with customers to build emotional engagement and customer advocacy. Develops and applies deep customer knowledge and intimacy to develop and deliver products, services, and interactions that provide value beyond expectations.
Executes for results – effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints. Embraces change, applies new knowledge and reconfigures quickly to capitalize on opportunities.
Understands or becomes knowledgeable of quality monitoring and improvement activities.
Licenses and Certifications
Health Services\LPN - Licensed Practical Nurse - State Licensure currently licensed to practice in Louisiana with graduation from an accredited vocational or technical school for Practical Nursing 180 days required.
Current Compact…